This handout is for lung cancer screening (ldct, adult). Your care team identified this based on: routine preventive/wellness visit — adult 50-80 with smoking history; assess ldct eligibility (uspstf 2021 grade b pmid 33687470).
Other reasons your team may use this plan: overdue or never-screened eligible smoker identified at any encounter — close the screening gap (uspstf 2021); plcom2012 6-yr risk ≥1.3-1.7% — risk-model-based eligibility expands beyond the uspstf pack-year rule (tammemägi nejm 2013 pmid 23425165); lung-rads-driven recall — prior screen-detected nodule due for interval ldct or diagnostic escalation (acr lung-rads v2022).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| low_dose_chest_ct_annual | LDCT annually, age 50-80, ≥20 pack-yr, current or quit <15 yr | imaging | annual | NLST (Aberle NEJM 2011 PMID 21714641): 20.0% lung-ca mortality RR + 6.7% all-cause RR vs CXR; 24.2% positive rate; 96.4% of positives false-positive over 3 rounds; NNS ~320 (NCI). Initial-round sens 93.8% / spec 73.4% (Church NEJM 2013 PMID 23697514). NELSON (de Koning NEJM 2020 PMID 31995683): cumulative lung-ca death RR 0.76 men / 0.67 women at 10 yr, 2.1% referral rate with volumetric Lung-RADS. |
| plco_m2012_risk_model_eligibility | PLCOm2012 6-yr risk ≥1.3-1.7% threshold | n/a | at eligibility assessment | Expands LDCT to higher-yield candidates missed by the categorical rule: PLCOm2012 sens 83.0% vs USPSTF 71.1% at matched spec (62.9% vs 62.7%), 41.3% fewer cancers missed (Tammemägi NEJM 2013 PMID 23425165; Ten Haaf PLoS Med 2017 PMID 28376113). |
| lung_rads_v2022_ppv_followup | Lung-RADS v2022 category → PPV → action | n/a | each LDCT | Category IS the likelihood ratio: 1/2 (<1%) annual; 3 (~1-2%) 6-mo LDCT; 4A (5-15%) 3-mo LDCT or PET; 4B/4X (>15%) tissue/PET/MDD (ACR Lung-RADS v2022). |
| varenicline | 0.5 mg PO daily ×3 d → 0.5 mg BID ×4 d → 1 mg BID | PO | BID × 12 wk (extend to 24 wk) | Most effective monotherapy; LDCT mortality benefit is conditional on cessation — cessation alone is 3-5x the benefit of early detection in the NLST cohort (USPSTF 2021). RxCUI 591622 RxNav-verified 2026-05-16 (tty=IN). |
| bupropion | 150 mg PO daily ×3 d → 150 mg BID, start 1-2 wk before quit date | PO | BID × 7-12 wk | Second-line cessation pharmacotherapy; may combine with NRT (USPSTF 2021). RxCUI 42347 RxNav-verified 2026-05-16 (tty=IN). |
| nicotine | Patch 21 mg/24 h (>10 cig/d) + short-acting gum/lozenge PRN | transdermal | daily patch + PRN short-acting | Combination NRT (long-acting patch + short-acting) ≈ varenicline efficacy; integrate at every screen (USPSTF 2021). RxCUI 7407 RxNav-verified 2026-05-16 (tty=IN). |
Plan: Lung — annual LDCT + integrated smoking cessation (USPSTF 2021 Grade B PMID 33687470; NLST PMID 21714641; NELSON PMID 31995683)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
STOP-screening logic (the deprescribing-equivalent): discontinue when the patient has not smoked for ≥15 yr, OR develops a health problem substantially limiting life expectancy, OR is unwilling/unable to undergo curative lung surgery (USPSTF 2021). Patient education on the false-positive rate (NLST 96.4% of positives benign over 3 rounds), the NNS (~320 to prevent 1 lung-cancer death), overdiagnosis, and the value of NOT screening when harm dominates (USPSTF 2021 PMID 33687470; NLST PMID 21714641)
Guideline: USPSTF 2021 Lung Cancer Screening Recommendation Statement (JAMA 2021;325:962-970, Grade B) + ACR Lung-RADS v2022 + PLCOm2012 risk-model eligibility (Tammemägi NEJM 2013); USPSTF 2021 re-verified CURRENT 2026-05-16 (not superseded 2021→2026)